Medication therapy management is one of the most evidence-supported interventions in pharmaceutical care, yet one of the most consistently underutilized. The Centers for Medicare & Medicaid Services (CMS) requires Part D plan sponsors to offer Comprehensive Medication Reviews (CMRs) to beneficiaries who meet eligibility criteria based on chronic condition burden and polypharmacy. But converting an eligible beneficiary into a completed CMR requires outreach, scheduling, patient engagement, and follow-through—a process that is far more operationally demanding than the clinical review itself.
CMS data from 2023 shows that the national average CMR completion rate for Medicare Part D standalone prescription drug plans was approximately 21 percent. That means nearly four out of every five eligible beneficiaries never received a CMR. For MTM companies and plans whose star ratings—and the significant revenue bonuses attached to them—depend on that completion rate, closing the gap is an urgent priority.
The Outreach Problem at Scale
The bottleneck in MTM completion is almost never clinical capacity. Pharmacists qualified to conduct CMRs are available. The bottleneck is reaching eligible beneficiaries and converting contacts into scheduled reviews. Eligible beneficiaries may not recognize their plan's outreach calls as coming from a trusted source, may be hard to reach during daytime hours, or may require multiple contacts before agreeing to a scheduled session.
Working through a large list of eligible beneficiaries with the persistence and consistency needed to maximize contact rates is labor-intensive. It also does not require clinical expertise—it requires organized, professional, patient outreach capacity. This is exactly the work virtual assistants do well.
A trained VA can work assigned beneficiary lists, make initial contact calls, document attempted contacts, and schedule confirmed appointments directly into the MTM platform calendar for the reviewing pharmacist. Contact rate and scheduling rate both improve because the outreach work gets done systematically rather than sporadically.
Documentation Intake and Pre-CMR Preparation
A Comprehensive Medication Review is most efficient when the reviewing pharmacist has a complete, organized medication list before the call begins. Assembling that list requires gathering information from multiple sources: the plan's claims data, the beneficiary's pharmacy records if available, and the patient's self-reported medication and supplement list obtained through pre-call intake.
Virtual assistants can conduct the pre-CMR intake call or form-based intake process, collecting the medication list, confirming current diagnoses, and entering the data into the MTM platform in a structured format. When the pharmacist begins the CMR, they have a complete medication profile rather than spending the first portion of the session gathering basic information. This preparation step improves both the quality and efficiency of the review.
Follow-Up Action Plan Communication
A completed CMR generates a Personal Medication List and a Medication Action Plan for the beneficiary. CMS requires that these documents be sent to the patient and, with patient consent, to the prescriber. Ensuring timely delivery, confirming receipt, and following up on high-priority action plan recommendations—prescription adjustments, prescriber consultations, drug interactions requiring resolution—involves communication tasks that extend beyond the clinical session itself.
Virtual assistants can manage the post-CMR communication workflow: sending document packages, confirming receipt, tracking prescriber notifications, and documenting the outcome in the platform. For MTM companies managing thousands of completed reviews per month, this post-session documentation and communication work represents significant labor hours.
Improving Star Ratings and Plan Relationships
CMR completion rate is a directly rated measure in CMS's Part D star ratings system. A one-star improvement in Part D rating can translate to hundreds of millions of dollars in quality bonus payments and enrollment growth for large plans. MTM vendors whose completion rates consistently exceed benchmarks maintain stronger plan relationships and command better contract terms.
For MTM companies looking to scale outreach capacity and close the completion rate gap, Stealth Agents provides trained virtual assistants who can manage beneficiary outreach, scheduling, intake documentation, and post-CMR communication workflows. Their healthcare-trained VAs work within MTM platform environments and follow established communication protocols.
The eligible beneficiaries who never receive a CMR are the patients MTM was designed to help most—those with the most complex medication regimens and the highest risk. Virtual assistants help ensure those patients get reached.
Sources
- Centers for Medicare & Medicaid Services. 2023 Part D Medication Therapy Management Program Fact Sheet. cms.gov
- Pharmacy Quality Alliance. Measuring MTM Performance: CMR Completion Benchmarks, 2023. pqaalliance.org
- Journal of the American Pharmacists Association. Barriers to MTM Completion in Medicare Part D, 2022. japha.org